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Home health providers will get rate increases for a 2nd year.
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For a very long time, as costs and understaffing increased, home and community-based services in Ohio pleaded with state lawmakers and governors to give them more Medicaid money to no avail.
Under Gov. Mike DeWine, the industry – adult day care, assisted living, home care and others offering less intensive alternatives to nursing homes – is finally seeing the needle moved.
“I want to give credit to the administration and to the General Assembly, because finally we have broken that cycle,” said Pete Van Runkle, head of the Ohio Health Care Association. “There was a 10-plus year cycle of no increases in assisted living reimbursement. Same was true with home care.”
Beginning in November, providers will see Medicaid reimbursement rate increases – albeit still not enough – for the second budget cycle in a row.
And with the COVID-19 pandemic worsening existing issues while highlighting more need for home-based care, significant federal COVID-19 relief funding is on its way.
On the state level
Advocates say that aging in home is significantly less expensive and more accessible for disabled Ohioans, and safer than a skilled nursing facility, despite a history of fraud.
The average cost of care for in-home services can be $1,225 per month, said Beth Kowalczyk, policy officer for the Ohio Association of Area Agencies on Aging. Nursing facility care is estimated to cost $6,361 per month.
Yet for many years, Medicaid reimbursement for home-based care has not come close to meeting the actual costs, groups have said. A nursing visit that costs $95 on average is reimbursed at $54, said Lisa Von Lehmden Zidek, with the Visiting Nurse Association of Ohio.
The gap widened more when the pandemic increased costs and wages.
“The other home care agencies are simply not accepting Medicaid patients. They’re not taking on the financial loss,” Zidek told lawmakers last week. “Only the agencies that will take Medicaid are getting flooded with even more Medicaid referrals.”
People have to be turned away, leading to more stress on nursing facilities where COVID-19 issues for congregate settings are well known, say home health care advocates. Those on Medicaid, who are low-income or disabled and stand the most to benefit from at-home care, lose out.
Long-term trends estimating a greater share of Medicaid folks to receive in-home care instead of in a facility are only adding to the pressure.
Almost 200,000 Ohioans on Medicaid are enrolled in a home and community-based services program as of June, per state data. Upwards of 60% of individuals with Medicaid coverage are choosing home and community-based settings.
Increases in reimbursement rates can make a dent into that cycle. In 2019, Ohio committed to giving 3.25% increases for just two home-health programs as well as some more money to the direct care workforce.
This year, all home and community-based health programs are set to see a 6.1% increase in rates in November. That’s estimated to be more than $57 million coming in, with at least $20 million of that from the state, according to the Legislative Budget Office.
But to really address the issue, it’ll take more than continually increasing reimbursement rates, said Joe Russell, executive director of the Ohio Council for Home Care and Hospice. He’s advocating that care underMedicaid gets paid more like Medicare is in the state.
Medicaid reimburses on a “fee for service” model. If a direct care nurse visits a home for just 15 minutes, for instance, the home care agency gets reimbursed lower than if the nurse had visited for 45 minutes.
Under Medicare’s “pay per visit” model, the amount is the same no matter the length of the visit. That gives a lot more flexibility for home care providers, said Russell.
“Tracking the amount of time a nurse is visiting is a regulatory burden,” he said. “It costs the same amount of money to send a nurse no matter the length of the visit.”
Federal help
The federal government, recognizing the importance of home care in light of the COVID-19 pandemic, is also beefing up cash to the sector through the American Rescue Plan Act.
The temporary 10% bump in the federal share of Medicaid funding for home and community-based health care means that Ohio will get a total of $460 million between April of this year and March of 2022.
The state has until March 2024 to use that additional money to make changes to the home-health system. While one-time, immediate needs from the coronavirus will be considered, the goal is to pinpoint more sustainable, long-term investments, Ohio Department of Medicaid Director Maureen Corcoran told lawmakers.
Providers in home care are eyeing the federal money and have already submitted feedback to the department on how to use that funding.
While most are looking at using money from increased reimbursement rates to help agencies make ends meet, they want to dedicate much of the federal aid to improve wages and work conditions for direct care workers, said Jordan Ballinger, policy director for Disability Rights Ohio, part of the Ohio HCBS Coalition.
“They’re making $12 an hour and Ohio’s estimated $13 an hour is what meets basic needs,” he said. “I think we should go above and beyond basic needs for these direct care workers.”
Workforce development is also another big priority, with issues exacerbated by the pandemic. Videk said since the beginning of 2020, around half of visiting nurses have left.
She told lawmakers she was thinking of hopefully using some of the federal money to create a program targeting students to thinking about becoming at-home providers, paired with tuition reimbursement.
“If we have a stream of employees coming through the organization that are basically raised by our organization, four years out from now I don’t believe we’re going to have the shortage that we have,” she said.
The Medicaid department released a vague, initial plan in June that outlined eight categories for potential projects, from workforce development to telehealth. The agency is in the process of incorporating feedback to create a more detailed plan.
Even with all the anticipated financial help, problems plaguing home health care are likely here to stay for now.
“Over the past 10 years, we have shifted from a crisis in this workforce and provider rates to really an emergency,” said Ballinger. “We’re going to continue to take hits on our HCBS system.”
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.